NECK LUMPS Flashcards
what makes up 80% of all salivary gland tumours?
parotid tumour
80% of parotid gland tumours are
a) benign
b) malignant
a) belign
give 5 malignant causes of parotid tumour
Which one is the most common
Mucoepidermoid carcinoma--> most common adenocarcinoma SCC adenoid cyst carcinoma facial nerve tumour/palsy
Is a thyroglossal duct cyst mobile or immobile?
mobile
what causes a thyroglossal duct cyst?
descent of thyroid gland
what is the name of the procedure used to remove a thyroglossal duct cyst
sistrunk procedure
give 3 infective causes of salivary gland swelling
mumps HIV bacterial parotitis CMV EBV
give 3 systemic/autoimmune causes of salivary gland swelling
sjoren’s syndrome
sarcoidosis
wegener’s granulomatosis
what immune cells are affected by acute lymphoblastic leukaemia?
B
T
what is the pathophysiology of ALL?
uncontrolled proliferation of immature cells
ALL leads to failure of what?
bone marrow
in what age group is ALL most common?
a) infants
b) children
c) middle aged
d) elderly
b) children
give 6 symptoms of ALL
anaemia infection bleeding bone pain organomegaly fatigue
what 2 chromosome is associated with ALL?
Which is more common
t(12;21) most common abnormality and counts for 30% of cases
philadelphia (9:22)
CLL affects mainly which immune cells?
B cells which are mature in appearance but are actually immature and nonreactive causing immune response
what is the pathophysiology of CLL?
proliferation of immature B cells and accumulation in the bone marrow, blood, liver, lymph nodes and spleen
what percentage is CLL of all leukemias?
a) 1%
b) 25%
c) 50%
d) 75%
b) 25%–> most common leukemias
what group are mainly affected by CLL?
a) young females
b) young males
c) old females
d) old males
d) old males
where might you expect pain in CLL? why?
LUQ (splenomegaly)
what is a cystic hygroma?
lymphatic malformation causing a mass
what is a infantile haemangioma?
A benign tumour of cutaneous blood vessels on the face of a child.
Occurs after birth, blood lump
how common is infantile haemangiona?
a) 1-2%
b) 10-12%
c) 20-30%
d) 40-50%
b) 10-12%
are infantile haemangiomas more common in males or females?
males
infantile haemangoimas tend to proliferate in the first __ months and settle before the age of __
9
4
what is chronic myeloid leukaemia?
uncontrolled proliferation of myeloid cells
what percentage of all leukemias is CML?
a) 1%
b) 15%
c) 40%
d) 60%
b) 15%
what age group is most commonly affected by CML?
middle aged
which of these words does not describe CML?
a) chronic
b) self-limiting
c) insidious
b) self-limiting
why is CML associated with gout?
purine breakdown
where might you expect pain in CML? why?
LUQ- splenomegaly
What chromsome is linked to CML?
Philadelphia (9:22)
80% of cases
what is acute myeloid leukaemia?
Is it more common in males or females?
blast cell proliferation from myeloid bone marrow
M>F
what is the most common acute leukemias in adults?
AML
which leukemia can arise as a complication of chemotherapy
AML
give three symptoms of marrow failure characteristic of AML
anaemia
infection
bleeding
what is the prognosis of AML like?
poor
what is hodgkin’s lymphoma?
proliferation of lymphocytes that accumulate in lymph nodes
which is the rarest of hodgkin’s and non-hodgkins
hodgkin’s more rare
what are the B symptoms classic of HL and NHL?
fever
night sweats
weight loss
which cells are characteristic of HL?
reed-sternburg cells (multinucleated giant cells)
what viral infection is linked to HL?
EBV mononucleosis
what staging is used for HL?
Describe the stages
ann-arbour
Stage 1: single lymph node group involvement
stage 2: multi lymph node groups involvement on same side of diaphragm
stage 3: multi lymph node groups on both sides of diaphragm
stage 4: Extranodal involvement plus lymph nodes
what is non-hodgkin’s lymphoma?
Malignant tumour of lymphoid cells but can also be found on in other cells such as lung, skin, esophageal cells
which cells are most commonly affected by NHL?
B
what type of lymphoid cells can be affected by NHL? which is more dangerous?
mature or proliferating
proliferating more dangerous
B symptoms are more common in HL or NHL?
HL
give 3 viruses associated w NHL
EBV
herpes
HIV
give a bacteria associated with NHL
h pylori
what occupational exposure can be associated w NHL?
farms (pesticide exposure)
what is the childhood version of NHL?
burkitt’s
which chromosomes are translated in burkitt’s?
8 and 14
give an example of a drug treatment for NHL
rituximab
along the border of which muscle would a brachial cleft abnormality run?
sternocloidomastoid
what can brachial cleft abnormalities predispose to?
URTIs
who do brachial cleft abnormalities normally affect?
young adults
What are the 4 classifications of Hodgkin lymphoma?
Nodular sclerosis
Mixed cellularity
Lymphocytic depleted
Lympochytic rich
What classification are 5% of all Hogdkin lymphoma?
Nodular lymphocyte predominately hodgkin lymphoma
Popcorn cells
What are the risk factors of HL?
Smocking Immunodeficiency Obesity EBV FHx
What 2 organs can enlarge in HL?
Splenomegaly and hepatomegaly
What are the initial symptoms of HL and NHL?
Painless lumps in the lymph nodes–> neck, groin and axilla
Except for B symptoms what other symptoms do you get with HL?
anorexia
Pruritus
Fatigue
How do you diagnose HL and NHL?
biopsy and bloods
What are the treatments for HL and what is the survival rate?
Chemo and Rado
BM transplant
5 years
What can NHL be divided into?
High grade and low grade NHL
What is the 2 most common types of B cell NHL?
Diffuse large B cell lymphoma
Follicular lymphoma
What are the 2 most common types of T cell NHL?
Peripheral T cell lymphoma
Skin lymphoma
What autoimmune conditions are associated with NHL?
RA
Hashimotos
Does having previous cancer treatment and FHx of NHL increase chance of NHL?
yes
As well as B symptoms what other symptoms might you get with NHL?
Anaemia, bleeding, pancytopenia, infection
NHL can spread to the bone marrow causing reduction in RBC,WBC and platelets what is the effect?
Tired (RBC)
Bleeding and brusing (platelets)
Infection (WBC)
IF NHL goes into the lungs what are common symptoms?
Difficult breathing, swallowing and coughing
IF NHL goes into the abdomen what are common symptoms?
Weight loss, tummy pain and indigestion
Is high grade or low grade NHL curable?
High grade
What percentage of people with
a) high grade
b) low grade
survive 5 years?
a) 30%
b) 50%
What treatment is given to NHL that is
a) local disease
or
b) diffuse disease
a) radiotherapy
b) monoclonal antibody
Give a example of monoclonal antibody?
Rituximab
Which is more common HL or NHL and by how much?
NHL is 5 times more common
What is Warmiths tumour?
The second most common benign salivary gland neoplasm that occurs in 60’s of females and 70’s of males
What are the red flags for parotid/salivary gland tumour
Facial weakness/palsy
Sudden increase in size
Paraesthesia/anaesthesia of neighbouring nerve
Intermittent pain/restlessness
Ulceration of the skin around the infected area
During parotid tumour investigation US is initially is done why is then MRI or CT done?
If deep tissue is infiltrated
What is the treatment for parotid tumor?
Radiation, parotidectomy ( careful dissection of facial nerve) and laryngectomy
Surgery is difficult due to the positioning of facial nerve and relapse often happens
What bacteria commonly causes bacterial parotitis that causes salivary gland swelling?
Staph Aureus
What are the three stages of treating ALL? Explain each stageWhat
Induction–> initial stage and killing all the leukaemia cells in the bone marrow= restore balance to the cells and resolve any symptoms
Consolidation–> Kill any leukaemia cells in the CNS
Maintenance–> Regular chemotherapy to ensure no relapse
What are the risk factors for ALL?
Smocking ( even parents smoking) Previous chemotherapy Obese Genetics Immunodeficiency
Do patients with CLL commonly present with symptoms?
Over 90% are asymptomatic and incidental finding on routine blood test
How do you diagnose CLL?
Blood test –> increase WCC 5* 10(9)/L
Blood film
Lymph node and BM biopsy
What are the three stages of CLL?
Stage A–> have enlarged lymph glands in less than 3 areas but increase WBC count
Stage B–> have enalrged lymph glands in 3 or more areas and increased WCC
Stage C–> all glands are enlarged and splenomegaly and increase WCC but decreased RBC and/or Platelets
At what stage do you start giving treatment for CLL and what is that treatment?
Chemotherapy and Stage B and C
What is the least commonest leukaemia of the 4?
CML
There are 3 stages of CML explain each stage?
Initial chronic phase, usually asymptomatic with little blast cells. Last for average of 4-5 years with incidental finding
Transformation phase–> increasing amount of blast cells and developing of symptoms
Blast phase–> mainly blast cells and resembling AML
What symptoms are commonly seen in transformation stage of CML due to increase production of blast cells
Anaemia
Serious infection
Blood clotting problems
What are the
a) B symptoms
b) additional symptoms and signs
you ge tin CML?
a) Night sweats, fever, tiredness (from anaemia) and weight loss
b) splenomegaly, hepatomegaoly, reccurent infections, petechiaea and lymphadenopathy
What is the main treatment for CML and how does it work?
Imatinib tablet –> tryosine kinase inhibitor
It inhibits tryosine kinase a enzyme that is produced by Philadelphia chromosome and involved in the abnormal growth and behaviour of the cells
What is mucoepidermoid carcinoma linked to ?
Cytomegalovirus
What are the characteristics of mucoepidermoid carcinoma?
Slow growing, palpable and firm mass
Squamous cell and mucus secreting
What tumour can cause mets in the parotid?
Phyllodes tumour of the breast
What is the characteristic of adenoid cyst carcinoma?
Well differentiated and slow growing
What is the complication with treatment of Parotid tumour?
Frey’s syndrome which is damage to the auriculotemporal nerve and causes sweating when eating
What is the cause of salivary gland stones and the symptoms?
Crystallised salivary deposits
Block the saliva causing pain and swelling
What is SIALADENITIS ?
What are the symptoms?
It is infection of the salivary gland when it is blocked
Affects one side of the gland and you get bad taste in the mouth due to the pus drainage
What are the risk factors and complications of sialadenitis?
RF–> dehydration and malnutrition
Complication –> Abscess, sever pain and fever
What is the cause of cyst in salivary swelling and what is the symptoms?
Tumour, infection, trauma and stones
Interfere with speaking and eating
What are the symptoms of SJORGREN’S SYNDROME
Dry mouth and eyes
Bilateral painless enlargement of glands
Treatment for salivary gland swelling
Manual removal of stones
Surgery in extreme cases
Abx for bacterial infection
Sour candies to increase salivary flow
Which of the leuekmia is associated with gout?
CML due to breakdown of purine
